Nutritional Screening in Older Adults First Results from WP2 of the - PowerPoint PPT Presentation

Nutritional Screening in Older Adults First Results from WP2 of the MaNuEL project Lauren Power, University College Dublin, Ireland On behalf of the MaNuEL consortium

CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report

What is Malnutrition Screening?

Breast Cancer Prostate Cancer Cervical Cancer Examples of Mammogram test DRE test Pap smear test Clinical exam PSA test HPV test Screening Visual inspection Programmes Quick Simple Valid

Principles of Effective Screening Programmes Precise, valid The Condition and reliable Should be a public health problem Incidence, prevalence and natural history known The Screening Programme Principles of Simple and safe Cost-effective good Precise, valid and reliable Cost-effective screening Cut-off levels defined and agreed Acceptable to the target population Agreement on further diagnostic investigation practice Strong Evidence Base Strong evidence base Chosen based on setting, local resources and practicability Certain parameters should have adaptions for the elderly population e.g. BMI Can be conducted by a multi-disciplinary team Chosen based on Intervention setting, practicability An appropriate follow-on plan should be agreed Follow-on plan should be acceptable and effective Wilson and Jungner 1968

..a quick and easy procedure using a validated nutritional screening tool Malnutrition (NST), designed to identify those who Screening are at risk of malnutrition and may is… benefit from nutritional intervention by a nutritionally trained professional (ESPEN 2002)

Community Rehabilitation Institutions Hospital Malnutrition - Questionnaires - Anthropometrics - Biochemical measures - Subjective measurements Screening (physical function/ social/ cognitive function) Quick Simple Valid

½ hospital wards screen for malnutrition risk Schindler K. et al. (2010) Clinical Nutrition 21% screened with validated NST Eglseer D. et al. (2017) Nutrition Why are we Barriers Organisational culture concerned Competing priorities about The value of clinical judgement nutritional Training and Education Discrepancy between attitudes and practice screening? Green et al. (2013) Journal of Human Nutrition and Dietetics 30% increase in identification of malnutrition - Improves malnourished patients nutritional status - Reduced length of hospital stay Kruizenga H.M. et al. (2005) American Journal of Clinical Nutrition € 2 per patient on admission

Nutritional concerns in older Nutritional concerns in adults adults: Many are inevitable ↓ Bone Mineral Why should we Reduced Density treat Dietary Intake ↑ Oxidative ↓ Immune nutritional Stress Function screening Physiological Concerns Malnutrition Risk differently in older adults? Disease- ↓ Muscle ↓ Vitamin Protein-Energy Related Mass Absorption Malnutrition Malnutrition ↓ Gastric Mobility

Why should we treat nutritional screening differently in older adults? Hospitalisation Many other determinants of malnutrition risk in older adults Cognitive Poverty Impairment Not enough to assess anthropometrics alone in this Malnutrition group BMI 18.5 kg/m 2 - consistently found to be an unreliable in Poly- Mobility older populations pharmacy

Nutritional screening tools validated in older adults Mini Nutritional Assessment Malnutrition Universal Screening Tool (Short Form) (MUST) Both recommended by ESPEN 

Work Package Aim: To create an overview of existing tools for malnutrition for older MaNuEL Work adults Package 2 ________________________________________ Work Package Objectives: “Malnutrition - Literature review on tools validated in older adults screening in - Creation of a database of tools used in older adults older adults” - Creation of a scoring system to rate tools - Devise recommendations on the best screening tools for use with older adults

Tools validated in older adults (no. studies) 34 (n=97) Community Rehabilitation Institutions Hospital 19 (n=32) 5 (n=6) 11 (n=17) 22 (n=51) African NST (n=1) African NST (n=1) Chandra NST (n=1) CNAQ (n=1) Ayrshire NST (n=1) CNAQ (n=1) Chinese NST (n=1) MNA-SF-V2 (n=1) CNAQ (n=1) Chinese CNS (n=2) Canadian NST (n=1) MST (n=1) DETERMINE (n=5) DETERMINE (n=1) CONUT (n=3) NUFFE (n=2) ENS (n=1) GNRI (n=1) CNAQ (n=1) SNAQ US (n=1) GNRI (n=1) MNA-SF-V1 (n=1) EVS (n=1) MI (n=1) MNA-SF-V2 (n=3) GNRI (n=5) MNA-SF-V1 (n=5) MST (n=1) GMS (n=1) MNA-SF-V2 (n=3) MUST (n=4) Icelandic NST (n=1) MNA-self (n=1) RS (n=1) MEONF II (n=1) MRST-C (n=1) SNAQ RC (n=1) MNA-SF-V1 (n=8) MRST-H (n=1) MNA-SF V2 (n=1) MUST (n=2) MRST-H (n=2) NRAT (n=1) MST (n=5) NUFFE (n=2) MUST (n=7) SCREEN (n=1) NRS-2002 (n=6) SCREEN II (n=2) NUFFE (n=1) SNAQ NL (n=1) NNSA (n=1) SNAQ 65+ (n=1) NURAS (n=1) RS (n=1) SNAQ US (n=1) SNST (n=1)

3 equally weighted domains: max. 45 points 1. Validation 2. Parameters 3. Practicability Scoring Validated in the Some are more Time System elderly suitable for an elderly 0-3 min Yes/No population/are more 4-6 min practical measures 7-10 min Criteria Type of Validity than others -Construct Cost/access -Criterion Lower Score e.g. Free + + -Predictive - Albumin Not Free - Calf Circumference Validated Against MNA, SGA or clinical Higher Score e.g. Used By assessment -Recent weight loss -Nutritionally trained staff only -Reduced appetite -All staff Validation Results Se, Sp, k-values etc. Adjustments for the Languages Elderly English only Amount of English plus other EU languages validation studies Max. 15 points Max. 15 points Max. 15 points

Hospital: Mini Nutritional Assessment Short Form (MNA-SF) Malnutrition Screening Tool (MST)

Community: DETERMINE Your Health Checklist

Rehabilitation: The Nutritional Form for the Elderly (NUFFE)

Institutions: Short Nutritional Assessment Questionnaire Residential Care (SNAQ RC )

Malnutrition screening… - is of utmost importance in older adults Take Home Messages for - should be considered differently in older people compared to the general adult population Geriatric Medical - should be setting specific Professionals - systems should be put in place in all healthcare settings and prioritised

Prof Clare Corish Dr Marian A.E de van der Schueren Dr Eileen Gibney Dr Michelle Clarke Acknowledgements Prof Jürgen Bauer Dr Susanne Leij-Halfwerk Ms Laura Bardon The MaNuEL consortium